And I Didn’t Even Mention Viagra

frolicnaked

Proper positioning.

For my last several pelvic examinations, this has not meant scooching farther down so my bum practically hung over the end of the exam table. Even though my reproductive organs were undergoing the exam, the "positioning" I speak of had much more to do with my feet.

Proper positioning.

For my last several pelvic examinations, this has not meant scooching farther down so my bum practically hung over the end of the exam table. Even though my reproductive organs were undergoing the exam, the "positioning" I speak of had much more to do with my feet.

Or rather, the stirrups.

Covering the stirrups at my last exam were what I can only describe as little "booties" advertising Valtrex. These particular booties were new to me, but the general concept was not. I can also recall booties for Yasmin, Premarin, Seasonique, and Lybrel, though not necessarily in that order.

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At this very moment, other windows and other tabs — which admittedly contains one tab of online shopping — show me ads for Levitra, Cymbalta, and Lyrica.

I haven’t even turned on the TV.

Still, it would seem that NPR is right: drug ads of the direct-to-consumer variety now abound. And the result on our health care system — including cost — is steep:

Prescription drug spending is the third most expensive cost in our health care system. And spending seems to grow larger every year. Just last year, the average American got 12 prescriptions a year, as compared with 1992, when Americans got an average of seven prescriptions. In a decade and a half, the use of prescription medication went up 71 percent. This has added about $180 billion to our medical spending.

 

The salient question here is, I think, the same as it’s been before: to what purpose? What does this increased patient-targeted advertising actually do for us?

If it’s properly treating or managing conditions and improving quality of life for people, then I’ll the the first to say "fuck it" to however much money is being spent. It’s hard to argue with dollars spent making people healthier or making their lives more livable.

That said, given how many other types of advertising encourage people to buy and use products they don’t actually need, it’s probably not any great leap to suggest that increased prescription ads — as well as increased prescription use — result in some level of waste.

Take this, from Julie Donohue, a professor of public health quoted in the NPR story:

"Something like a third of consumers who’ve seen a drug ad have talked to their doctor about it…. About two-thirds of those have asked for a prescription. And the majority of people who ask for a prescription have that request honored."

 

Then look at the number of Internet and bootie ads I happen to remember right now. If I did ask, how many of those are costs that are worthwhile or medications I need?

Commentary Law and Policy

The New McCarthyites: Lists, Lies, and the GOP’s Attacks on Women’s Health Care

Jodi Jacobson

McCarthyism is defined in the dictionary as the practice of making accusations unsupported by proof or based on slight, doubtful, or irrelevant evidence, and the practice of making unfair allegations or using unfair investigative techniques especially in order to restrict dissent or political criticism. I'd say today's radicalized GOP has them both down pat.

Watching last Tuesday’s congressional hearing on Planned Parenthood by the House of Representatives Oversight and Government Reform Committee felt less like viewing a bona fide hearing in the sense of fact-finding or rational questioning by capable public servants on issues of public import than it did, variously, like witnessing an inquisition, a series of performances in theater of the absurd, and raising Joe McCarthy from the dead.

Ostensibly, these hearings were called to investigate claims by an anti-choice group known as the Center for Medical Progress (CMP) that Planned Parenthood was profiting from the sale of fetal tissue. This in turn gave House Republicans a reason to call for “defunding” Planned Parenthood. But there has never been any actual evidence offered by CMP or anyone else to support the charges of profits from the sale of fetal tissue, which is widely used in critical health research and has long been regulated under federal law. No evidence was offered at the hearing either. None of the congresspeople had seen the full, unedited versions of these videos, which have yet to be publicly released by CMP, though they’d had months to ask for them. In fact, that same day, Missouri became the sixth in a list of states that have wasted taxpayer money on investigations that found the claims to be baseless. (Never mind that the Missouri Planned Parenthood clinic does not even offer fetal tissue donation, but you know, let’s investigate anyway.)

The sale of fetal tissue isn’t and never really was the point of this hearing nor in fact of the videos themselves. Rather this attack is yet another salvo in a very long, large, and well-organized campaign to destroy the single largest provider of reproductive and sexual health care in the United States. As noted by CMP founder David Daleiden in an interview with Politicohis agenda is to bring down Planned Parenthood by any means possible. Because after all, why worry about the lives and health of the three million people a year who get services at Planned Parenthood clinics when you have political points to score and a reputation to make.

But hearings were of course held anyway, because if there is anything the GOP hates more than gun regulations and immigrants, it’s the ability of women to get access to health care whether it be contraception, abortion, testing and treatment for sexually transmitted infections, or breast exams.

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Cecile Richards, president of the Planned Parenthood Federation of America (PPFA), appeared at the hearing voluntarily, but that did not prevent her from having to take five hours of abuse. Watching in real time, I quickly understood there were three reasons for this hearing. One was to try as much as possible to humiliate Richards, who, apart from being a political force in her own right, is also the daughter of former Texas Democratic Gov. Ann Richards, a Democrat herself, a former chief of staff for Nancy Pelosi, and the head of both a powerful health-care provider and a powerful political action committee. Attacking Richards covers a lot of bases for right-wing hate-mongers. Several House members appeared committed to doing anything possible to trip Richards up such that she said something, anything, they could perhaps later use as fodder for campaign ads and another round of attacks.

A second reason appeared to be to further obfuscate the issue of funding for reproductive health care such that the GOP could find “better” uses for that money.

Finally, and most insidiously, taking a page right out of the playbook of Sen. Joseph McCarthy, this hearing was about taking names and getting lists of providers, of clinics, of staff people and even of organizations providing family planning services abroad for the purposes of harassing and stigmatizing them, if not more.

The most aggressive tactics apparently meant to humiliate or trap Richards were used by Congressmen Trey Gowdy (R-SC) and Jim Jordan (R-OH). As the following videos show, they each asked leading questions of Richards, and, before she could even begin to reply they interrupted, answered for her, and then twisted what she had managed to say in reply. In fact, throughout the hearing, GOP congresspersons asked convoluted questions only to cut Richards off any time she tried to respond.

Gowdy didn’t bother with questions about fetal tissue, body parts, or funding. Instead he ran off the rails with irrelevant questions about whether or not Richards understood “how some of us may at a base level disagree with you on the origin of life?” He then went on to badger her about her opinions on abortion and on so-called partial birth abortion, neither of which were relevant to the stated purposes of the hearing and the latter of which does not exist.

Jordan focused on a Planned Parenthood video featuring Richards and made in response to the first release by CMP. He badgered Richards about this video, without allowing her to reply.

The effort to confuse the public around funding for Planned Parenthood was at first raised obliquely by House committee chairman Jason Chaffetz. He opened the hearing with a tearful though disconnected story about his personal family losses from cancer. Chaffetz said:

This is an important topic. The risk of getting a little—a little personal. My wife, Julie and I have been married some 24 years. Have our 25th wedding anniversary coming up in February.  I’m proud of my wife. She… she got her degree in psychology later in life after helping to raise three kids, some are still at home. She has just started to work [with] a plastic surgeon [who is] involved in helping women who are having to have their breast removed. And my wife (inaudible) helping these women. And I’m proud of her for doing that.

My mother—she passed away when I was 28 years old. She fought cancer for more than 10 years. She had breast cancer. And I miss her.  I lost my—I lost my father to cancer as well. Cancer, in this country, kills about 1,500 people a day. A day. And yet, our federal government only spends about $5 billion to fight it. If they were shooting 1,500 people a day, if there were rockets coming—we would be fighting this with everything we have got.

Then, Chaffetz continued:

And as I said before I came to Congress and I’m saying here today, as fiscally conservative as I can possibly be, we don’t spend enough on cancer. We don’t spend enough. We need to spend more. I would quadruple the amount of money if I had my chance to fight cancer and win. And the reason I’m passionate about the hearing today is we got a lot of health care providers, who, I think, in their hearts know that they’re trying to provide good.

The question before us is, does this organization—does Planned Parenthood really need federal subsidy? Does it need federal dollars? Every time we spend a federal dollar, what we’re doing is pulling money out of somebody’s pocket and we’re giving it to somebody else. What I don’t like, what I don’t want to tolerate, what I don’t want to become numb to is wasting those taxpayer dollars.

It is not at all unusual for congresspeople to use personal stories in hearings. Normally, however, such stories are relevant to the subject of the hearing itself. Cancer research was not relevant. It is funded through the National Institutes of Health, the budget of which was cut by Republicans in March of this year.

This hearing was about the federal funds that support services delivered by Planned Parenthood, which come through two avenues, either reimbursement of services for patients who qualify for Medicaid, or through funding to support Title X family planning services. To suggest funds for cancer research have anything to do with funding for these services reveals either that Chaffetz did not know his facts, or he was playing on sympathy as a guise for suggesting there was a choice to be made between the two. In the same way that the GOP either truly does not get it or purposefully misunderstands the actual process women go through to get mammograms (first a primary caregiver provides a referral, then you go to a radiologist), they seem bent on pretending that switching funds from Planned Parenthood to other purposes is a better use of money. We’ll have to watch for these comparisons to be made later.

But what was perhaps the most insidious aspect of the hearing were the “lists.” As the hours wore on, there were repeated requests for Richards to send the committee lists of everything from the organizations to which Planned Parenthood provides funding overseas to the names and contact info for clinics and providers. In the 1950s, former Sen. Joe McCarthy touted lists he claimed proved communists had infiltrated the U.S. government. He used those purported lists (which did not actually exist) to create fear and intimidate people throughout the country, and to haul them in front of Congressional committees. He ruined many lives. And it appears his spirit lives on in the contemporary GOP now in power.

Reproductive health providers know about lists. A number of organizations in the anti-choice movement have been known to make and publish lists online, including the names of doctors and service providers of abortion care, the names and addresses of clinics, and the home addresses of those who work at clinics. These lists are used to intimidate, target, follow, and sometimes harm or murder abortion providers and staff. Some state attorneys general have tried to use their power to obtain the records of women who have had abortions, and in at least one case, that of former Kansas State Attorney General Phill Kline, information gathered by his office was shared publicly and with anti-choice groups. And now, since CMP released its videos, there have been a number of attacks on clinics throughout the country.

Chaffetz started taking names and making lists almost immediately. He began with a question about the Democratic Republic of Congo (yes, you read that right, straight from fetal tissue to the DRC):

CHAFFETZ: Ms. Richards, Planned Parenthood has sent 32-plus million dollars in grants overseas. Does any of the funds go to the Democratic Republican of the Congo?

RICHARDS: Congressman, let me…

CHAFFETZ: No, no, no. We don’t have time for a narrative. I just want to know…

(CROSSTALK)

CHAFFETZ: Yes or no.

RICHARDS: You asked me a question. Any of the money that is — Planned Parenthood raises and is given by foundations and individuals to support family planning services is in Africa and Latin America, and they go to individual organizations.

I’m happy to provide you a list of those organizations, but I did not bring them with me.

CHAFFETZ: If you could give us a list of those organizations.

Chaffetz then asked for a list of Planned Parenthood’s “ownership in foreign companies,” a somewhat strange request to a nonprofit, but…

CHAFFETZ: Does Planned Parenthood have any ownership in foreign companies?

RICHARDS: I don’t believe so. I don’t know what you mean by ownership.

CHAFFETZ: Well, in your 2013 tax return, it lists $3.3 million marked as, quote, “investment,” unquote in Central America and the Caribbean. I’m just asking if that investment was an actual investment?

RICHARDS: We don’t own anything in those countries. What…

CHAFFETZ: OK. Let me keep going. I have to keep going. I need to — I would appreciate a list. You have been very cooperative so far.

Congresswoman Cynthia Lummis (R-WY) picked up this thread by asking for a list of affiliates that “receive the majority of their revenue from abortion.” Lummis insinuated that there must be something wrong with Planned Parenthood’s data on the share of services for abortion, given revenues from abortion appear higher than those from other services. Her line of questioning was wholly misleading. Surgical abortion is more costly than other services, and those services are not reimbursable by Medicaid or other government funds, so the revenue stream is not relevant to the share of services provided. It’s like asking a dentist why she brings in more money for root canals than teeth cleanings.

Chaffetz, however, did not want to let that point go by, and so he reiterated the request when Lummis was done. “[A]s a point of clarification, Ms. Richards, I want to make sure there’s no ambiguity here. The gentlewoman from Wyoming asked for a listing of affiliates where the majority of revenue comes from abortion services. You said you’d talk to your team. Will you actually provide us that list?”

Like Joseph McCarthy, GOP members of the hearing panel then went on to suggest some sort of guilt by association with President Obama and the Department of Justice.

JORDAN: Since the videos have surfaced have you had any conversations with the President of the United States?

RICHARDS: No I have not.

JORDAN: Since the videos have surfaced have you been to the White House?

RICHARDS: No I have not.

JORDAN: How many times have you been to the White House?

RICHARDS: During what period of time?

JORDAN: Since Mr. Obama’s been president.

RICHARDS: I don’t know that’s been I think seven years, so I would have to get back to you on that.

JORDAN: Our count shows that you, your board members and senior staff have been to the White House 151 times in six and a half years. I’m just curious, that’s why I ask the question if you’ve been to the White House or you talked to the President since these videos have surfaced?

RICHARDS: And I said I have not.

JORDAN: And you’ll get back with me on if the Justice Department has contacted you since these videos have surfaced?

RICHARDS: Well I think you listed several folks, so I’m happy to work with the committee and find out what all you need to know.

JORDAN: CMS, HHS, Inspector General, Justice Department; Justice Department’s the most important.

Was President Obama featured in the CMP videos? I don’t think so either.

Chaffetz then once again stepped in and reiterated the list of lists being requested, and added a couple more.

CHAFFETZ: We are looking for the amount of revenue by affiliate for abortion services. So you have the — that should be pretty straightforward. We would like to know which affiliate provides which services.

RICHARDS: I believe you have that, but we’re happy to provide that.

CHAFFETZ: We’re still—we want to make sure we’ve it crystal. I think we have portions of it, but we don’t have all of it.

RICHARDS: OK.

CHAFFETZ: The names of organizations and the countries that Planned Parenthood gives funds to overseas. So based on the tax returns and reports, you’re sending money to overseas. Some of them have been listed as investments, so as other things, we’d like to get some details and specificity as to how much is going to which country and what those are for. Is that fair?

RICHARDS: I really have to talk to my team about that but I will.

And:

CHAFFETZ: We obviously, have some concerns about the Planned Parenthood Action Fund. So we’re trying to get to the duties performed and compensation received for all Planned Parenthood or affiliate employees. This could either by for the Planned Parenthood Action Fund or for either of the — I believe there are two, 5207 organizations. One of our concerns, is that the shared services and the sharing of employees between political actives and non-political activities and we would like to understand how broad based that is.

CHAFFETZ: [And] the cost of reimbursement for both contraception, and abortion, and abortion obviously breaks down into in clinic as well as the pill.

RICHARDS: Actually, there’s a lot of kinds of contraception too.

CHAFFETZ: Yes, contraception, I left it as broad as I could. But for the abortion services…

RICHARDS: I’m just saying, I think it’s important, I’m not sure we got into much of that conversation about how birth control—how many different kinds of birth control there are now because that’s one of our specialties.

CHAFFETZ: Help us understand and what services and money you’re allocated and what the costs of that are. There were some points that should be helping to drive down those costs and we’re just not understanding the ratio…

RICHARDS: That’s why…

CHAFFETZ: It needs clarification. I’m not asking…

RICHARDS: It was clear that folks weren’t aware of the various costs of different kind of contraceptions..

CHAFFETZ: Exactly, and that’s where we need help. Not right now, just as a follow up.

And:

CHAFFETZ: A list of political organizations, Planned Parenthood collarbones, including the names in compensation of received of shared employees.

I think I covered that in general, but I’ll keep going.

Yes, it seems they will keep going, as one means of spreading fear and intimidation.

There are two definitions of McCarthyism in the dictionary:

  • the practice of making accusations unsupported by proof or based on slight, doubtful, or irrelevant evidence.
  • the practice of making unfair allegations or using unfair investigative techniques especially in order to restrict dissent or political criticism.

I’d say today’s radicalized GOP has them both down pat.

Commentary Human Rights

Cisgender Women Aren’t the Only People Who Seek Abortions, and Activists’ Language Should Reflect That

Cheryl.Chastine

As an abortion provider, I now make a practice of using gender-inclusive language—not only when speaking about the issue on traditional and social media, but also when talking to my patients.

In a column for The Nation last Friday, writer Katha Pollitt questioned the push among reproductive justice activists to use gender-inclusive language when talking about abortion. Pollitt claimed that such rhetoric “render[s] invisible half of the population and 99.999 percent of those who get pregnant.”

I’m a physician who provides abortions. I’m a physician who provides medical therapy for transgender patients. Both areas of care, for me, are aspects of the same commitment: to provide necessary, lifesaving services that center my patients’ autonomy. Still, I’ll readily admit that I, too, was confused at first by calls to use language with regard to reproductive rights and justice that would be inclusive of transgender men and nonbinary individuals. It seemed like common sense to me that of course my pregnant patients were women and would be referred to as such. As a progressive, though, one of the important lessons I’ve learned is that what looks like “common sense” is often a reflection of unexamined biases. And I’ve realized that assuming every person seeking an abortion is a cisgender woman just further reproduces the prejudices that render transgender people invisible and vulnerable.

On the same day The Nation ran Pollitt’s piece, Reuters reported on a survey of trans men regarding health-care use; more than three-quarters of the individuals had transitioned medically, meaning they were using hormone replacement therapy and/or had obtained surgical treatment. Forty-two percent of the respondents reported experiencing health-care discrimination, including denial of equal treatment, verbal harassment, and/or physical assault. Furthermore, the survey respondents disproportionately reflected a privileged minority of transgender individuals: white, college-educated, employed, privately insured trans men. That figure is undoubtedly higher among less well-off demographic groups of trans men and nonbinary people.

Cisgender people, particularly white individuals, have the privilege when seeking health care of being able to present as their authentic selves without fear. Transgender people, especially people of color, do not. Dr. Kortney Ryan Ziegler, an Oakland, California-based filmmaker, writer, and scholar who is also a Black transgender man, told me that for himself and other trans men he knows, the experience of accessing medical services is fraught with bodily exposure and the risk of discrimination.

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For instance, while traveling out of town once, he went to an urgent care clinic for a cold. “The nurse noticed I had a prescription for testosterone and asked me about it. So I ‘came out’ to some random [registered nurse] because I had a cold, [even though] it had nothing to do with anything else,” he said.

He also recalled clearly how, while still presenting as a Black “woman,” “there were many times I know my race played an important role in how I was (mis)treated.”

Explicitly inclusive language is meaningfully beneficial to people like Ziegler, he says, because it can help ameliorate the harms of the fear of being harassed or mistreated: When such rhetoric is used, it can signal that trans men and nonbinary trans people are more likely to be acknowledged and accepted as themselves.

As an abortion provider working in a conservative area of the country, I’ll readily state that nearly all of my patients present as cisgender women. Does that mean that they all are cisgender women, though? We live in a cisnormative society, meaning that the experiences of cisgender people are overwhelmingly centered. In addition to the aforementioned risk of health-care discrimination, visibly trans individuals are subject to employment and other economic discrimination, family and partner rejection, housing discrimination, and a very real danger of violence. When this is the known price of coming out as trans, it’s one many people feel unable to pay.

Feminists like Pollitt who argue against inclusive language assert that because “99.999 percent of the population” seeking abortions are cis women, it is inaccurate and inappropriate to use gender-inclusive language. So how many trans people are we really talking about? It’s more than 0.001 percent. Suppose you time-traveled back to the 1950s and asked the average physician how many of his or her patients were gay. They would probably respond, “None” or, “Maybe one or two.” It’d be easy to conclude, therefore, that 99.999 percent of all people were straight, so there’d be no need to include any forms of non-heterosexual orientation in language or activism. Assuming the proportion of non-heterosexual people has stayed roughly constant, though, our 1950s physician likely did have a number of gay, lesbian, or bisexual patients. The doctor simply took them to be heterosexual. They may have even presented themselves as such, out of a legitimate fear that the physician would behave prejudicially toward them.

Using the same logic, how can providers or activists dare to presume that every patient we can’t “read” as trans is cis? Numerous trans individuals “pass” as a cis member of their gender, or they present—in some or all settings—as a cis member of their assigned-at-birth gender.

So the truth is, we don’t know what proportion of the population is transgender. The blog FiveThirtyEight covered this last year: No national surveys ask the question, and “even if they did, the responses might not be reliable because some people are afraid to answer, while others disagree on what ‘transgender’ even means.” But we do know that trans and genderqueer people within the reproductive rights movement are calling, in significant numbers, to be included.

When those in the reproductive justice movement prioritize trans inclusivity, more trans individuals feel comfortable publicly identifying as such. Furthermore, that visibility can guide people who’d previously lacked the tools to articulate their feelings of difference. Anna Rubin, who was assigned female at birth, identifies as agender, and uses the pronoun “they,” says they were able to figure out they were trans while researching the best uses for inclusive language at their then-employer, a reproductive rights nonprofit.

When writing a blog post for the nonprofit, Rubin had used the term “trans*.” The use of the asterisk is controversial: Some cisgender people have advocated for the asterisk to include transvestites, who are cisgender, so many trans people feel that it represents an attempt by cis people to encroach on the trans identity. “Somebody called me out on using [the asterisk],” Rubin said. “Wanting to do the right thing pushed me toward resources that helped me figure me out.”

In turn, that self-realization equipped Rubin with a way to push back against gendered language.

“Even before I figured out that I was trans,” Rubin said, “I’d not identified strongly with the label ‘woman.’ [So] it was kind of an overload when I came onboard [the organization] and started getting hammered with it. I felt so alienated before I even figured out why.”

This, Rubin continued, reflected the implicit and explicit discrimination they saw in the wider movement. “I was also made uncomfortable by the lack of respect shown to trans people in the movement. … It was really hard to hear, ‘I think genderqueer people are just confused,’ when I was trying on the label ‘genderqueer’ for myself,” they said.

As a result, Rubin said, “I was miserable under the weight of the assumptions. … I feel like I rushed myself out of the closet in order to confront them with someone they needed to respect. Because when I tried to advocate for myself, and people like me, without being able to say, ‘Hey, this is important to me as a trans person,’ I got such disappointing pushback. [But] once it was pointed out that there was a real problem that affected a real person that they saw every day, they changed.”

Parker Molloy, a journalist who is a transgender woman, sees gendered pro-choice slogans of the past as entirely compatible with an increasing understanding of gender variation—and a corresponding update to our word choice. For example, with regard to the frequently invoked phrase “Trust Women,” Molloy said, “In its truest, most earnest form, it is a promotion of bodily autonomy. It’s trusting an individual to make their own choices, and eliminating gatekeepers. … Trans existence and identities push back against social expectations, push back on the idea that someone else should be given control of our bodies, and push back on the concept that biology is destiny.”

“Trust Women,” in other words, is a call to respect bodily autonomy, and that same respect can now compel us to update our language.

The category “women” doesn’t map neatly onto the category “people who can get pregnant,” and not just because people who aren’t women can and do get pregnant. Many women, conversely, are unable to get pregnant. Some of those women are trans, and others have reproductive tract anomalies that make pregnancy impossible.

In addition, reproductive justice advocates, including trans activists, have called for deemphasizing anatomical language as a rallying call. A trans-inclusive worldview is one that acknowledges that there are women (and nonbinary people) who have testes and penises, and men (and nonbinary people) who have vulvas and vaginas. A laser focus on genital anatomy is one of the major ways that cisgender gatekeepers exclude, ostracize, and disbelieve trans people. Cisgender solidarity around presumed shared genital anatomy, too, is a way trans people are excluded and erased. Given that, it makes sense that centering reproductive rights language around specific anatomy can strike trans people as both deliberately exclusionary and reinforcing of their dysphoria.

Furthermore, rejecting anatomy-centered language is also about centering lived experiences. Objections from trans people and supporters to the constant association of “abortion” with “vaginas” have often been met with ridicule from many, including left-liberals: “How could abortion not be about vaginas? It involves a vagina! That’s how you get pregnant and where you have the abortion!”

To that I would simply ask: Is parenting about vaginas? Or, if you prefer: Is motherhood about vaginas? Would we use vaginas as the symbol of parenthood? Should we title, say, a maternity-leave advocacy group “Lady-Parts Leave Equality”? Should a proposed affordable child-care bill be called the “Vagina Defense Alliance”?

We wouldn’t, because we see that parenthood is about lives and families, and incidentally involves vaginas in the physical logistics along the way. Abortion, too, is about lives and families. Historically, it’s been anti-abortion activists who wanted to make abortion about naughty, dirty sex and vaginas; pro-choice activists saw abortion as being about autonomy, the full realization of all of us as humans, whether or not we have the capacity to get pregnant. So it’s perplexing to me to see mainstream left-liberals insisting on titling their abortion events after genitals. I’m all for refusing shame, but that’s an emphasis that detracts from the actual significance of abortions for the people having them.

And, again, it is not as if gender-inclusive language hurts cisgender women. As an abortion provider, I now make a practice of using it—not only when speaking about the issue on traditional and social media, but also when talking to my patients. Never once have I felt that any of my cisgender patients was harmed, confused, or distressed by my talking about “pregnant people.”

When we frame abortion access around autonomy, we should also understand this parallel: Justice for transgender people, too, is a question of bodily and personal autonomy. As physicians and as reproductive justice activists, we are called to recognize each person’s right to inhabit their true gender, rather than participate in forcing them into the category they were assigned at birth. That means that we must give primacy to people’s understanding of themselves. We can’t advocate that each pregnant person be able to effect the best decision for themselves—while simultaneously insisting that people who aren’t cisgender should go along silently with language in which they don’t exist.

As Molloy put it, “Abortion is an issue of bodily autonomy. Being trans is an issue of bodily autonomy. Abortion is a trans issue.” And, I’ll add, transness is a reproductive justice issue. The movement can’t deny trans people a seat at the table in the abortion conversation; they were already there. It’s up to everyone else to acknowledge them.